2012 May-Jun;32(3):309-11.


A fatal case of cutaneous adverse drug-induced toxic epidermal necrolysis associated with severe rhabdomyolysis.

Noordally SO, Sohawon S, Vanderhulst J, Duttmann R, Corazza F, Devriendt J.


Dr. Sheik Oaleed Noordally Department of Critical Care Medicine, Centre Hospitalier Universitaire de Tubize-Nivelles, Site de Nivelles, Rue Samiette 1, 1400 Nivelles, Belgium T: +32-02-4773483, F: +32-02-4773484 Sheikoaleed.Noordally@chu-brugmann.be.


Toxic epidermal necrolysis represents an immunologic reaction to a foreign antigen and is most often caused by drugs. Atorvastatin, a blood cholesterol-lowering agent, is a recognized cause of rhabdomyolysis; while naproxen, a widely used nonsteroidal anti-inflammatory drug, is a known cause of photo-induced skin lesions. We report the first fatal case of drug-induced toxic epidermal necrolysis associated with severe muscle necrosis due to the use of a nonsteroidal anti-inflammatory drug and a statin with very high levels of creatine phosphokinase leading to acute kidney injury, disseminated intravascular coagulation, and complete skin necrosis leading to death



2004 May;31(5):951-6.

A population based historical cohort study of the mortality associated with nabumetone, Arthrotec, diclofenac, and naproxen.

Ashworth NL, Peloso PM, Muhajarine N, Stang M.


Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Alberta, Canada. ashworth@cha.ab.ca



To identify the unbiased differences in all cause mortality among populations using 4 non-steroidal antiinflammatory drugs (NSAID): nabumetone, Arthrotec, diclofenac plus a cytoprotective agent dispensed separately (diclofenac+), and naproxen.


We performed a population based historical cohort study using linked data from several provincial health care databases. Logistic regression was used to produce estimates of the mortality associated with the study drugs unbiased by known confounders. The entire population of the province of Saskatchewan, Canada entitled to drug plan benefits in 1995 was eligible (approximately 91% of 1 million people). Participants were identified if they filled a prescription for one of the 4 study NSAID (18,424 individuals). They were then followed forward in time for 6 months to determine all cause mortality.


Compared to nabumetone, the adjusted odds of death for participants taking Arthrotec was 1.4 (95% confidence interval, CI: 0.9-2.1), for diclofenac+ 2.0 (1.3-3.1), and naproxen 3.0 (1.9-4.6).


The multivariate analysis showed patients taking nabumetone and Arthrotec had significantly lower mortality than those taking other study drugs. Nabumetone had 1/3 to 1/5 the mortality associated with the diclofenac+ and naproxen groups. It appears that inherent gastroprotective strategies in the study NSAID may translate into decreased mortality at the population level.



Hypopharyngeal Stenosis and Dysphagia Complicating Toxic Epidermal Necrolysis

Jose E. Barrera, MD; Arlen D. Meyers, MD; Edward C. Hartford, MD

A 43-year-old woman with a history of alcohol abuse developed repetitive biopsy-proved TEN thought to be secondary to the ingestion of naproxen sodium (Aleve) and aspirin.

Within the next 24 hours, sloughing of the skin over her face and trunk, skin tenderness, oral and vaginal mucosal desquamation, and erosions of the palate were evident.....

The possible association between the patient's use of naproxen and aspirin and the onset of skin eruption suggests that the TEN and its sequelae were probably caused by nonsteroidal anti-inflammatory drug use. ....